pancuronium and Cough

Infantile tracheomalacia is a potentially life-threatening disease requiring prolonged artificial respiratory support. Diagnosis and management of this disease may be further improved by establishing a suitable objective and quantitative assessment protocol for tracheal collapsibility. It is our hypothesis that tracheal collapsibility can be represented by the relationship between intraluminal pressure and the cross-sectional area of the trachea. To test this hypothesis, static pressure/area relationships of the trachea were obtained from anesthetized and paralyzed infants, who were diagnosed as having tracheomalacia by endoscopic observation. These relationships were fitted on a linear regression model, followed by calculation of the estimated closing pressure. The tracheal closing pressure ranged from -8 to -27 cm H(2)O, suggesting easy collapsibility of the trachea during crying or coughing and noncollapsibility during the spontaneous respiratory cycle, which coincided with the infants' symptoms. It is our conclusion that tracheal collapsibility of infants with tracheomalacia can be quantitatively assessed by the static pressure/area relationship of the trachea obtained under general anesthesia and paralysis.

Topics: Airway Resistance; Anesthesia, General; Body Weight; Bronchoscopy; Case-Control Studies; Compliance; Cough; Crying; Cyanosis; Female; Gestational Age; Humans; Hypnotics and Sedatives; Infant; Linear Models; Male; Manometry; Midazolam; Neuromuscular Nondepolarizing Agents; Pancuronium; Predictive Value of Tests; Pressure; Respiratory Mechanics; Tracheal Diseases; Video Recording

The purpose of the study was to determine the effect of nondepolarizing muscle relaxants and waiting time on muscle fasciculations after succinylcholine in anaesthetized patients. Adult men and women, 60-80 kg, received pretreatment doses of atracurium 5 mg (n = 160), pancuronium 1 mg (n = 123), d-tubocurarine 3 mg (n = 97), or vecuronium 1 mg (n = 62). Waiting times between pretreatment and succinylcholine, 100 mg, ranged between 0.6 and 5 min. Data points (presence or absence of fasciculations and waiting time) were entered for each patient. Waiting time response curves were obtained between the logit transformation of the probability of no fasciculations and the log waiting time for each drug. Statistical differences between wait time response curves were determined by non-overlapping of the associated 95% confidence intervals. The frequency of muscle fasciculations was reduced with increased waiting time for all nondepolarizers tested. Following wait times of three, four and five minutes, the probability of not fasciculating was greatest with d-tubocurarine (90, 97 and 99%, respectively) and atracurium (89, 93 and 96%). Corresponding values for pancuronium were 70, 82 and 88% and for vecuronium were 74, 82 and 86%. Waiting times to prevent fasciculations in 80% and 90% of patients were shorter with d-tubocurarine (2.46 and 3.02 min, respectively) or atracurium (2.16 and 3.24 min) than pancuronium (3.77 and 5.35 min) or vecuronium (3.73 and 6.36 min).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Atracurium; Cough; Fasciculation; Female; Humans; Incidence; Intubation, Intratracheal; Male; Neuromuscular Nondepolarizing Agents; Pancuronium; Preanesthetic Medication; Prospective Studies; Sex Factors; Succinylcholine; Time Factors; Tubocurarine; Vecuronium Bromide